高龄老年应用氯吡格雷与阿司匹林抗血小板治疗的临床研究

目的对比研究高龄老年应用氯吡格雷与阿司匹林抗血小板治疗的效果及安全性。方法91例高龄老年冠心病患者随机分为氯吡格雷组(50 mg/d)、阿司匹林组(100 mg/d)及对照组(复方丹参滴丸10粒3次/d),药物治疗8周后,观察实验前后血小板聚集率改变、胃黏膜出血、对中性粒细胞及血小板的影响以及凝血三项的改变。结果与对照组比较,氯吡格雷组与阿司匹林组对血小板聚集率均有确切的抑制作用;在血小板聚集率抑制方面,氯吡格雷组优于阿司匹林组;各组实验前后均未出现中性粒细胞及血小板的显著变化;在胃黏膜损伤方面,虽然阿司匹林组发生例数较多,但各组均无显著差异;阿司匹林组及对照组实验前后凝血指标未发生变化,氯吡格雷组用药后活化部分凝血酶时间延长,与对照组比较有显著差异,而用药前两组无显著差异。结论高龄老年应用氯吡格雷与阿司匹林均能获得确切的抗血小板聚集效果,且较安全,其中氯吡格雷效果优于阿司匹林。

A clinical study on antiplatelet therapy with clopidogrel and aspirin in the very old patients

Objective To study the antiplatelet effects and safety of clopidogrel and aspirin in very old patients with cardiovascular diseases.Methods Ninety-one old patients aged over 75 with cardiovascular disease took part in the study.The patients were randomized to aspirin(100 mg daily) group,clopidogrel(50 mg daily) group,and the placebo group(Fufang Danshen Diwan 250 mg,tid).The treatment was continued for 8 weeks.Before and after the study,blood specimens were collected from all eligible patients to test the blood routine values,prothrombin time(PT),prothrombin activity(PA),activated partial thromboplastin time(APTT) and platelet aggregation rate(PAG),and gastroscopy was performed as well.Results Both aspirin and clopidogrel in this study could inhibit platelet aggregation significantly compared with placebo(P<0.05),clopidogrel was more effective than aspirin.There was no significiant difference in the occurrence of gastric bleeding among all groups.The decrease in neutrophil or platelet did not occur in all eligible patients.Aspirin had no effect on coagulation system,while APTT was prolonged significantly in clopidogrel group as compared with placebo group.Conclusions Both aspirin 100mg/d and clopidogrel 50 mg/d could inhibit platelet aggregation definitely and safely in very old patients with cardiovascular diseases,and clopidogrel was more effective than aspirin.